Section 21 Application Form

Please ensure all information is accurate before submitting this form. This is a signed form, and once submitted, it cannot be altered unless our team provides you with an opportunity to amend your submission during the review process. Double-check your details to avoid delays in your Section 21 license application.

Name
Related reason for the application to use unregistered medication.
Product List
Patient Consent - Eligibility Declaration:
I acknowledge that this medication/device is for managing my condition, not for research. Any research using my data requires my specific approval and SAHPRA oversight, with results shared with SAHPRA. I can request a copy of this form, which will also be available to my healthcare professionals.